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Topic

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Left hepatic vein

The left hepatic vein (LHV) is one of the three major hepatic veins that drain blood from the liver into the inferior vena cava (IVC). It arises from the confluence of venous tributaries from the left hepatic lobe, primarily from segments II and III of the liver, and occasionally receives drainage from segment IV (quadrate lobe).

It courses within the liver parenchyma, traveling superiorly and posteriorly, and typically joins with the middle hepatic vein near the hepatocaval junction before entering the IVC just below the diaphragm. The LHV is usually the smallest of the three main hepatic veins but is clinically significant in hepatic surgery, liver transplantation, and hepatic venous outflow obstruction (Budd-Chiari syndrome).

Synonyms

  • LHV

  • Vena hepatica sinistra

Function

  • Drains oxygen-depleted blood from the left lobe of the liver (segments II, III, ±IV)

  • Contributes to systemic venous return via the IVC → right atrium

  • Plays a critical role in hepatic venous outflow, essential for maintaining portal–systemic circulation balance

  • Serves as a landmark in hepatic resection and transplantation surgery

Tributaries

  • Segment II vein (left lateral superior)

  • Segment III vein (left lateral inferior)

  • Occasionally segment IV vein (medial lobe)

MRI Appearance

T1-weighted images:

  • Lumen appears as a signal void (black) due to fast venous flow

  • Surrounded by hyperintense hepatic parenchymal fat planes

T2-weighted images:

  • Flowing blood shows as a signal void; delineates hepatic venous anatomy against surrounding liver parenchyma

  • Thrombus may appear intermediate to hyperintense depending on age

STIR:

  • Fat suppression improves visualization against parenchymal background

  • Detects perivenous edema or infiltration in pathology

T1 Post-Gadolinium (Gd-enhanced MRI):

  • LHV enhances brightly and homogeneously during venous phase

  • Filling defects represent thrombus or tumor invasion

  • Essential in Budd-Chiari syndrome, venous obstruction, or hepatic tumor mapping

MRA (Magnetic Resonance Angiography):

  • Contrast-enhanced MRA depicts the origin, course, and confluence with middle hepatic vein/IVC

  • Valuable for transplant planning, venous anomalies, and pre-interventional mapping

CT Appearance

Non-contrast CT:

  • LHV is poorly visualized unless dilated or containing thrombus

  • Appears as a faint tubular structure near the left hepatic dome

CT Post-Contrast (CT Venography):

  • Enhances brightly during venous phase, showing drainage into IVC

  • Multiplanar and 3D reconstructions identify tributaries, confluence, and anatomical variations

  • Detects thrombosis, Budd-Chiari syndrome, extrinsic compression, or tumor invasion

  • Critical for hepatic resection, transplant surgery, and interventional radiology

MRI image

Left hepatic vein anatomy MRI axial image -img-00000-00000

CT images

Left hepatic vein ct axial